AB0510 COST-EFFECTIVE ANALYSIS OF GENERIC TARGETED SYNTHETIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUG - TOFACITINIB IN RHEUMATOID ARTHRITIS (TIRA CEA STUDY)
Authors: D. Syngle, I. Verma, K. Chauhan, S. Patyal, A. Syngle
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> With the introduction of generic version of tsDMARD tofacitinib in different parts of the world, its important to perform a cost-effective analysis of introducing generic tofacitinib to the current treatment sequence for patients with moderate-to-severe rheumatoid arthritis who have inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs-IR). <h3>Objectives</h3> Perform pharmacoeconomic analysis of introducing generic tofacitinib into the current treatment sequence for patients with moderate-to-severe rheumatoid arthritis who are csDMARDs-IR. <h3>Methods</h3> A prospective, observational study was conducted in 55 consecutive RA Indian patients (Table 1) meeting 2010 Rheumatoid Arthritis Classification Criteria with active disease and an inadequate response or intolerance to conventional disease-modifying antirheumatic drugs randomized to receive tofacitinib 5 mg bd as an add on therapy. All study patients attended the rheumatology OPD with 3 months follow-up. Average cost effectiveness analysis was done by taking HAQ-DI score as a measure of effectiveness. Total cost estimation included cost of the treatment, monitoring cost and adverse effect management. <h3>Results</h3> RA patients included in study had established disease with 18.18% males and 81.81% females and 49% were seropositive. Majority of the study RA patients (89%) were on a background regimen of two synthetic DMARDs (MTX and HCQ-80%, MTX and LEF-5.45%, SSZ and HCQ-3.63%,) and 1.81% of the RA patients were on a combination of three sDMARDs. After 3 months treatment with generic tofacitinib and other csDMARDS, the DAS-28 score improved from 5.31 ± 2.16 to 3.81±1.21, p≤0.001 and the mean disability index estimated by HAQ-DI reduced from 1.39± 0.60 to 0.62 ± 0.37, p&lt;0.001. The direct medical cost of treatment of RA per month is 3032.81 rupees (34.39 Euro or 37.31 USD). The average cost effectiveness ratio for the treatment with generic tofacitinib and continuing the use of csDMARDs was Rs 3,938.71 (equivalent to 44.67 Euro or 48.48 USD) to gain or improve one unit of HAQ-DI score. Cost percentage for each head is depicted in Graph 1. <h3>Conclusion</h3> Treatment with generic tofacitinib is effective to control the disease activity and improves disability in RA. Incorporating generic tofacitinib into the csDMARD treatment sequence in active RA patients who have inadequate response or intolerance to csDMARDs is effective to improve the disability index. These results, reflecting the additional costs associated with deteriorating health condition, support the importance of using generic tofacitinib. <h3>Reference</h3> [1]Syngle A, Kaur S, Verma et al. Cost-effective analysis of disease-modifying anti-rheumatic drugs in rheumatoid arthritis. <i>Clin Rheumatol</i> DOI 10.1007/s10067-017-3725-3. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.